More than 7.8 million people fled Ukraine since the invasion of Russia and are registered as refugees in Europe (as of November 1, 2022). Almost 89,000 of them are registered to the Netherlands (as of November 3, 2022). It is expected that this number will rise. Appropriate and accessible Mental Health and Psychosocial Support (MHPSS) is essential for conflict survivors to address psychological harm from traumatic events and distress both during the escape and after, while trying to adjust to an unfamiliar place. Receiving countries have the obligation to provide MHPSS as part of their international commitment to the right to health. This is recognized in the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of Persons with Disabilities (CRPD). Nevertheless, the Netherlands is failing to honor this commitment with fragmented services that do not seem to fit support needs. The longer it takes to put a comprehensive approach in place, the greater the damage to the refugees will be. This interactive session aims to shed light on practical challenges and opportunities for the implementation of appropriate, accessible and integrated MHPSS. What is needed to go from a fragmented to an integrated approach?

Being active as advisors in the field of Disaster Health and MHPSS in the Netherlands, the presenters review their experienced challenges thereafter opportunities and good practices are explored together with the participants.

Experienced challenges include complexity, fragmented organization, lack of ownership and inadequate access to knowledge and information about support needs.

More is needed to meet the commitment to the right of health and to provide adequate MHPSS to refugees in the Netherlands and beyond. International exchange and learning can help us to understand and overcome implementation challenges.

Pediatric patients represent a small (but important) subset of the patient population routinely visiting emergency departments (ED) each year. With the aim of better understanding the disaster preparedness level for pediatric-specific mass casualty and surge incidents, a survey was conducted involving all hospitals that routinely manage pediatric patients in their emergency departments, to better understand the preparedness levels for these facilities.

This is a retrospective analysis of data collected in 2014 and repeated in 2021. Our focus included one predominantly rural state in the United States of America (USA). We examined results from surveys conducted where facilities self-reported objective criteria that resulted in a readiness score (as it relates to pediatric readiness). Reporting stratification reflected the annual pediatric ED volume with groups of; Low (<1800/year), Medium (1800-4999 /year), Medium to High (5000-9999/year), and High (>10,000/year).

Low-volume hospitals scored (Mean=59/Median=56), Medium volume hospitals scored (Mean=62/Median=60), Medium to High volume hospitals (Mean=67/Median=65), and hospitals with High volumes (Mean=82/Median=83). All hospital volume ranges had outlier hospitals that scored between 82-97. The general tendency, lower volume hospitals had a lower level of readiness, and higher volume hospitals had a higher (to much higher) level of readiness.

Pediatric disaster readiness needs to be improved at the community level. It is encouraging that pediatric disaster readiness has been addressed in the larger medical centers. Yet, it should be noted that even very low-volume hospitals (had outliers with) scores as high as 94 indicating that with ample support, and resources, pediatric disaster preparedness is achievable in every hospital regardless of size or volume. The results point to a need to develop, improve, and distribute resources and support local hospitals with pediatric disaster readiness.

Children represent 25% of the population, have special needs, and are often over-represented in disasters. The New York City Pediatric Disaster Coalition (NYC PDC) is funded by the NYC Department of Health and Mental Hygiene (DOHMH) to improve pediatric disaster preparedness and response. PDC worked with a network of pediatric intensivists to create the Pediatric Intensive-Care Response Team (PIRT). PIRT consists of volunteer pediatric intensivists that currently practice in New York City.

Secondary transport may be requested by hospitals due to a mismatch of resources to needs for patients requiring critical and/or subspecialty care. The team is activated when a disaster involves a significant number of pediatric patients. In the proposed plan, the PIRT physician on-call will triage/prioritize the patients based on acuity and need for services and relay the necessary information to the transport agency. PIRT is designated to provide subject matter expertise and resources during real-world events. PIRT maintains a 24/7 on-call schedule with backup. The PIRT system was tested in four call-down communications drills and a tabletop exercise for prioritization of pediatric mass casualty victims.

The call-down drills demonstrated the ability to contact the on-call and backup physicians by email or text within 20 minutes and others within one hour. In the tabletop, PIRT members were given 15 patient profiles based on a scenario and asked to prioritize patients based on their injuries/medical needs. This was accomplished in less than 30 minutes, followed by a review and discussion of the rank order. A number of lessons learned were identified and will be presented.

The NYCPDC has developed and tested a PIRT that is available 24/7 to prioritize patients for secondary transport and offer subject matter expertise during pediatric mass casualty events. This model can be utilized to enhance pediatric disaster preparedness.

The key cripplers of health care are:

1. Fragmented Patient chart

Possible solutions:

• single cloud-based chart that is owned by the patient protected by the government

• information uploaded by a certified care provider (or they don't get paid)

• Maintained by a patient navigator who organizes information

• linked to self-care directions and

• tele-support clinicians

2. Disparate and rapidly changing medical treatments of variable support with evidence

Why can't we integrate all guidance into one set of current recommendations so that when you put your information into the patient's EMR, guidance pops up and you follow that.

Not only will that lead to consistency, you are essentially entering a patient into a clinical trial of sorts as this data can be reviewed later.

3. CME

• Fragmented, disparate, inconsistent.

• Make it a paid part of our salary making it mandatory, and consistent

4. Telemedicine

Create a Provincial or State or Regional Virtual hospital that Offers 24/7, Full hospital e-consultant services.

a. Tier one, e-Consultants support acute care issues.They help you decide regardless of where you are working the management and connect with a regional hospital bed registry so you can move your patient from your ED to a hospital with beds.

b. Tier two, e-Consultants who support in-patient rounds virtually in rural/remote settings with hospitalists. For example, an Internist could support and monitor a regional virtual ward and do rounds with in-house hospitalists on patients across the region.

C. Tier three would be the equivalent of an outpatient clinic, done virtually.

A STRONGERR website using Social Media tools will be created to determine if social media can be used to accelerate health care transformation to create a unified delivery system.

Website will be up by Dec 2022. Results April 2023.

To be determined.

The paper provides the perspective of emergency managers within a healthcare service, using a multi-agency framework to coordinate a regional response to COVID 19. While health services play a role in the planning, response and recovery to major emergencies they are rarely the lead in coordinating the response. The exploration of existing research through Pauchant and Mitroff Onion Theory is combined with the challenges and experiences faced by emergency managers during the COVID 19 response in Ireland. The research mirrors the experience of emergency managers that preparedness and relationship building are key to quickly establishing a response. However the experience of emergency managers was that although shared situational awareness is critical a flexible system framework is required, particularly in a prolonged pandemic situation. A hierarchical command and control system can negatively impact on strong local relationships and problem solving capability. The experience of emergency mangers concurs with research that the development of a learning organization is pivotal in information preparedness before and during the response and recovery phase. The challenges of implementing lessons learned across a national health service can be challenging especially during an extended response phase.

A deductive manifest analysis approach was adopted to carry out a qualitative thematic content analysis of exercise reports and emergency debrief reports.

Research Questions

Lessons learned in the five years prior to COVID 19 enhanced the response to the pandemic emergency–yes there are several examples of how lessons learned can improve response to seemingly unrelated emergencies.

The principals of the MEM Framework in Ireland are applicable to a pandemic emergency–yes but this is dependent on local arrangements and relationships to allow flexibility in the implementation of the framework.

Regular training and exercising as well as a debriefing of exercises and real emergencies enhances preparedness for emergencies.

Migration and forced displacement are reshaping the globe today. More people are being displaced by conflicts and natural disasters than ever before, and climate change is playing a pivotal role as a contributing factor for migration and conflict.

While there is a growing literature regarding provision of care for migrants in hosting countries there is no evidence on the use of the surge capacity model to support preparedness, readiness, and response to migration crisis by local health services, or medical teams.

A scoping review with a narrative summary relevant to disaster medicine, looking at two major migration routes (Central/Eastern Mediterranean and South/Central America) was performed to determine if the surge capacity model has been applied by medical teams responding to migration crises, and how this has affected the adaptation of health services.

Preliminary analysis demonstrates variations on the use of the term “surge capacity”, and the imperative need to better define its application when preparing to or responding to any type of disaster, here specifically migration crisis. Thus far, there is no evidence on the use of the surge capacity model for the conformation of national/international medical teams when responding to this type of crises, and its relation to the adaptation of health services. This is particularly relevant, as the surge capacity model can support building and/or strengthening the capacity and capability of national and international medical teams.

There is an imperative need to design a conceptual framework based on the surge capacity model for the conformation of fit-for-purpose medical teams, that ensures preparedness, readiness, and appropriate response to migration crises guaranteeing adaptation of health services depending on context needs, and that defines skills and competencies of the responders. Additionally, this provides a conducive platform for operational research activities to foster evidence coming from the field.

COVID-19 conforms to key baseline characteristics of disaster which is defined as “a situation or event that overwhelms local capacity, necessitating a request for national or international level of assistance.” Many countries faced shortages of health workforce, maldistribution, misalignment of needs and skills of healthcare workers.

The research goal is to identify the country responses on the shortage of workforce, their best practices and the lessons learned that may help to better handle any similar crisis in the future.

The scoping review was conducted in four electronic academic databases, namely, Medline, Web of Science, EBSCO, and TRIP and 24 scientific articles were reviewed. This study is funded by the World Health Organization Centre for Health Development (WKC-HEDRM-K21001).

The main strategies implemented were a financial coordination mechanism, relaxing standards/rule, redeployment, recruiting volunteers, fast tracking medical students, and using other resources in the workforce such as: the recruitment of inactive healthcare workers, returnees whose registration has lapsed within the last 1-2 years and integration of internationally educated health professionals. All these strategies demonstrated advantages like establishing mutual support across nations, organizations, motivating healthcare workers, lessening the workload of healthcare workers, and creating a new staff model for the next pandemic. If a pandemic lasts longer, financial support mechanisms are no longer feasible and longer working hours result in burnout. Managing volunteers, including supervision of their safety and allocation to the area in need, required hard effort and high-level coordination, especially when a needs assessment is unavailable. Another problem was the absence of an available list of resources, including volunteers and retired medical personnel.

To date, countries have not yet determined clear policies on how to ensure the sustainability and resilience of the workforce during major health shocks. A follow-up study investigating the strategies implemented is needed.

Molecular assay for diagnosing and detecting SARS-COV-2 is an essential tool in pandemic management, allowing for early informed decision-making. Worldwide, the gold standard for testing SARS-COV-2 includes real-time reverse transcription-polymerase chain reaction assay (RT-PCR). The Cepheid Xpert-Xpress was authorized for emergency diagnosis of SARS-COV-2. This platform demonstrated various advantages, including faster results, due to a decreased turnaround time, and decreased contamination risk. However, inconclusive results often leave clinicians uncertain regarding individual patient management decisions. Often leading to more confusion than answers.

The aim of this literature review includes the following:

• identify the frequency and clinical implications of inconclusive results for SARS-COV-2 diagnosis utilizing GeneXpert assay

• whether inconclusive results should be interpreted as negative

• assessing the reliability of the GeneXpert platform to diagnose SARS-COV-2

A narrative literature review was conducted with eight critically appraised articles which met the inclusion criteria.

After the initial data collection, the SANRA Framework was implemented to aid in the sorting and filtering of data. The analysis of data was conducted with a critical appraisal tool.

The GeneXpert SARS-COV-2 assay demonstrated high sensitivity and specificity. Studies indicated that inconclusive results associated with a high cycle-threshold value (CT-value) of more than thirty-five on the Cepheid Xpert Xpress were associated with a decreased viral load and, thus, decreased infectivity. However, numerous factors influence the CT-value, such as specimen integrity. Thus, results must not be interpreted in isolation.

This narrative literature review demonstrated the need for institutions to assist clinicians with decision-making regarding inconclusive results. A flow diagram grading a patient’s risk of having SARS-COV-2 with an inconclusive result could be of immense value. The flow diagram should incorporate the current epidemiology in the area, patient symptomology and risk and duration of exposure.

After a nuclear or radiological (nuc/rad) incident, there is a need to screen, potentially decontaminate, and monitor the affected population. A Community Reception Center (CRC) is a site that provides these services, plus more, to those displaced by a large-scale incident. By using CRCs, federal agencies and state, tribal, local, and territorial (STLT) health departments can monitor the affected population, help prevent hospitals from becoming overburdened with persons not critically injured, compliment shelter operations, and obtain a basis for a long-term registry. However, public health staff often are not fully trained in their CRC role and the decision-making factors.

The Centers for Disease Control and Prevention (CDC) developed a unique training board game, “This is a T.E.S.T.” (Tabletop Exercise Simulation Tool), for public health staff about their CRC role and decision-making factors. We play-tested the game with several CDC and STLT staff in 2022 and received informal feedback.

Players found the game facilitated discussion and identified gaps in CRC plans, safety hazards, population needs, and staffing requirements. They also said the game improved collaboration and communication. Over 90% of players strongly agreed the game accurately simulated both bottlenecks and resource needs, individual needs and anxiety, and allowed a greater understanding of CRC operations.

Games have been used for emergency response using different platforms such as virtual reality and video games. This is a T.E.S.T. facilitates collaboration by tasking players with managing resources, staff fatigue, public anxiety, and hazards. Players provided valuable feedback on its usability while learning more about CRCs. “This is a T.E.S.T” provides a unique, innovative training experience that incorporates components from typical tabletop and full-scale exercises, CRC capacity estimates through CDC’s CRC SimPLER (Simulation Program for Leveraging and Evaluating Resources), and key principles of adult learning.

Traumatic injury from road traffic accidents is a major cause of morbidity and mortality in Rwanda. Basic first aid training can help bystanders to provide prehospital care. The objective of this study was to determine the impact of Stop the Bleed (STB) hemorrhage control training on participant knowledge, attitudes, and practices regarding bleeding control.

A total of 64 participants from two community organizations (Healthy People Rwanda and the Rwandan Emergency Care Association) were provided with training in STB. The course included a didactic presentation and skills session where participants could practice skills. A KAP (Knowledge, Attitudes, Practices) survey was provided to participants before training, immediately after training, three months, and six months post-training.

Immediately after training, participant knowledge of bleeding control techniques improved across 5 of 7 questions, including correct tourniquet placement (98% vs 85%) and the correct order of steps to take when treating bleeding (63% vs 9%). There was also a significant increase in confidence across six measures: identifying life-threatening bleeding, applying a tourniquet, applying direct pressure, wound packing, treating severe active bleeding, and teaching bleeding control techniques to others (p<0.001). After three months, 100% (n = 21) of participants reported using at least one skill from the course, and 95.24% (n = 20) reported using at least one piece of equipment provided during the course. After six months, 93.33% (28 of 30) of participants reported using at least one skill from the course, and 86.67% (26 of 30) reported using at least one piece of equipment provided during the course. Notably, 17 participants reported using the tourniquet they had received by six months post-training.

This study found that STB training increased participant knowledge of bleeding control techniques and confidence in performing techniques for bleeding control. All participants reported using skills learned from the course.

Disaster medicine education is a huge challenge, but essential to disaster preparedness. While natural disasters have always been a part of world events, recent large-scale natural and man-made disasters have drawn attention to disaster medicine. As a consequence, medical schools in many parts of the world have begun to incorporate disaster-related topics into their curricula. However, in the territory of the former USSR, disaster medicine has just begun its development, and at the moment it is represented only in a couple countries, including Kazakhstan.

Data collection was performed using a database search through the Ministry of Education and Ministry of Healthcare of the Republic of Kazakhstan, Uzbekistan, Kyrgyzstan, Russian Federation, Belarus, and Ukraine. Disaster Medicine curricula on different education levels, including bachelor, graduate, and postgraduate levels were reviewed and analyzed.

Even though Kazakhstan is the ninth largest country in the world, education in the field of disaster medicine is currently represented only in one medical university in the country: specialists in disaster and emergency medicine are trained in residency and master's programs. In the Republics of Uzbekistan and Kyrgyzstan, education in the disaster medicine field is not provided, but there are electives for bachelor students. The Federal Center for Disaster Medicine, located in Moscow, offers doctors advanced training in disaster medicine, also disaster medicine education is provided at the bachelor and residency levels all over the Russian Federation. In Ukraine, at the moment, there is no training of specialists in disaster medicine, while in Belarus there are curricula at all levels of education.

Despite the fact that our life is impossible without catastrophes, most of the post-soviet countries are not having educational programs in disaster medicine. Using international experience could be beneficial so that every country will be prepared to face any disaster both locally and globally.

A widely acknowledged aspect of emergency preparedness is hospital-wide staff education. Maintaining interest in hospital emergency preparedness among hospital staff is challenging. A hospital-wide education process involving a robust lecture and hands on donning and doffing sessions followed by periodic disaster drills has been recently undertaken as a quality improvement process.

A prospective pre- and post-test study of 256 hospital staff were given a six-hour training course in comprehensive Hospital Incident Command Systems (HICS), Hazmat (Hazardous Materials), and CBRNE (Chemical, Biological, Radiation, Nuclear, and Explosive) events. The same pre and post-test were given to all participants that contained questions to assess emergency preparedness knowledge.

256 registrars within seven months (two classes per month) completed training with pre and post-tests. The average class size was 18.3 (range= 14 to 26 registrars). 3 of 256 (1.1 % 95% confidence interval) registrars achieved the pass mark of 70% in the pre-test survey and 230 (89.8 %) registrars achieved the pass mark in the post-test (χ2-test P < 0.001) with an absolute increase in the pass rate of 84%.

This finding justifies Emergency Preparedness Training at our institution, showing a marked improvement in staff knowledge of HICS and CBRNE management. This study should encourage continuous widespread use of Emergency Preparedness training in hospital Emergency Preparedness.

This study measured the impact of virtual three-level collaboration (3LC) exercises on participants’ perceived levels of collaboration, learning, and utility (CLU) at hospitals in the southern region of Saudi Arabia. Our 3LC exercise is a tabletop training tool used to facilitate disaster education and document CLU. This model enables the practitioner to acquire new knowledge and promotes active learning.

An English version of the CLU scale, the validated Swedish survey tool, was applied to 100 health-care managers or leaders in various positions at both the operational and tactical levels after conducting the 3LC exercises.

The results show that most participants strongly agreed that the exercises focused on collaboration (r2 = 0.767) and that they had acquired new knowledge during the exercises. There was a statistically significant association between participation in the collaboration exercises and perceived learning (r2 = 0.793), as well as between perceived learning and utility (r2 = 0.811).

This study confirms the feasibility of three level collaboration exercises conducted virtually. Our work also demonstrates that learning depends on collaboration practices and that collaboration exercises before crises can help to build qualities that people can apply in daily life. Collaboration elements exercised in this study contributed to perceived learning. There was a strong covariation between participation in the participants’ collaboration exercises and perceived learning and utility. The virtual three-level collaboration exercises were well received by the participants and achieved an acceptable collaboration, learning, and utility score. Although exercises were conducted virtually, they were well received by the participants and achieved a value M = 4.4 CLU score, which opens up new dimensions in collaboration simulation exercises, at least from an organizational perspective, in a world with an increasing number of disasters and public health emergencies.

The past three years have included multiple Public Health Emergencies of International Concern (PHEIC) and dramatically impacted all facets of Emergency Medical Response. During this time, simultaneous crises have demonstrated the value of the non-traditional responder in mitigating complex incidents. Current geopolitical climate has proliferated nuclear power and increases the necessity for readiness and awareness for radiological incidents. These are complex incidents a responder may face and requires even the lowest skilled practitioner to be fully engaged before special operations intervention.

Limited research exists to determine whether current emergency medical services (EMS) training supplies the competency necessary to ensure safety of the prehospital provider during a radiological incident. Forthcoming research will investigate the effectiveness of this current training within the United States.

Survey data will be collected from multiple providers across the United States to evaluate their confidence level on two primary objectives during a radiological incident: competency of personal protective equipment donning and doffing, and management of contaminated patients.

Data analyses of survey responses help drive future proposed educational activities that will be compliant with best practices set forth by organizations such as the United States Department of Health and Human Services Radiation Emergency Medical Management (REMM), the National Fire Protection Agency (NFPA), and Radiation Emergency Assistance Center/ Training Site (REAC/TS).

Data will be collected by survey responses to evaluate a diverse range of EMS services. Details such as skill level, type of EMS service, catchment of communities served, and their impressions upon the training will be analyzed.

This is an ongoing project that will embrace the perspectives of the diverse group of delegates of WADEM throughout and become enriched through the organization's wealth of knowledge. Gaps highlighted during roll-out of this research can also be used to address logistics, doctrine, and policy shortfalls.

Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the COVID-19 pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services (EMS), even in the accelerating environment of biothreats.

This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS providers. The survey was available for 1 month in 2021 during which 190 EMS providers responded to the survey.

Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a biological agent. Provider Clinical Competency levels ranged from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution, and community). Only 10% of the respondents were both willing and able to effectively function in a bioterror environment.

To effectively prepare for and respond to a bioterrorist attack, all levels of the healthcare system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed to biological agents. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system, which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.

Following the outbreak of hostilities in Ukraine and the resultant humanitarian crisis, the State of Israel deployed a field hospital inside Ukraine. Challenges included a large refugee population, disruption of routine medical services to the local population, first-time deployment of a civilian field hospital, and deployment to a country at war.

The activity of the field hospital during a deployment in Ukraine is described along with lessons learned for future deployments.

A Rapid Assessment Team (RAT) performed needs assessment and coordination with local authorities. The main necessity encountered was delivery of primary care to both the refugee and local population. During the 6 weeks of deployment, 6,161 patients were treated in the hospital. 65 patients were hospitalized and 59 underwent surgery. The hospital was completely digitalized. 103 remote consultations were performed using telemedicine techniques. Capacity building of local teams was given high priority and 796 Ukrainian health professionals underwent training.

Deployment of a national civilian field hospital in a country of war is possible through coordination with local authorities while undertaking the necessary security measures.

The change in caseload from expected war trauma to predominantly primary care necessitated agility in planning and operation with subsequent adaptation of hospital and staff structure.

The use of telemedicine enhanced capabilities, allowing access to consultation with the most experienced specialists in Israel.

Capacity building of local teams should be given a high priority. This was implemented by combining clinical training and the inclusion of a medical simulation unit in the hospital.

Dispatching a team delivering medical care and extending a helping hand in time of need, especially when done by a national entity, contributes greatly to building the people's faith, hope, and resilience during the crisis, and has a critical role in the recovery effort.

As health care professionals and family members, we know that many patients died alone in healthcare settings during the first six months of the COVID-19 pandemic. An extensive literature review confirms this as well, and concludes that visiting restrictions during the pandemic had negative impacts on patients and their loved ones.

There is a right to not die alone contained in the Dying Patient’s Bill of Rights; however, it happened time and time again during the early months of this pandemic when countless people in long-term care settings and hospitals were reported to be isolated during their final hours of life. No one should die alone! What can we learn from this experience to try to minimize this from happening during the next pandemic?

This study will explore the state of the literature on the status and impact of visitor restrictions during the COVID-19 pandemic, in conjunction with a survey of a defined sample of practicing registered nurses in the United States. This study seeks to respond to the primary research question of how patients’/family members’ end-of-life needs can be met in a pandemic when hospital visitation is severely limited or non-existent? There are for (4) related sub-questions concerning effective direct and indirect methods of family presence.

The literature concludes that countless people were isolated without family presence during their final hours of life during the first six months of COVID-19. The initial survey process is currently underway, with the identification and analysis of recommendations for improvement in early 2023.

The goal of this study is to develop best practices for meeting the end-of-life needs of hospitalized patients and their loved ones during a pandemic, so that to the extent possible, no one dies alone.

The National Ambulance Service (NAS) must transport patients with acute psychiatric needs to their nearest emergency department for assessment. Wexford General Hospital (WGH) does not have on-site medical psychiatric services after hours, in-patient psychiatric beds, or dedicated psychiatric doctors. Patients requiring formal acute psychiatric assessment and/or admission after ED review need to be transferred 60-80 km to other healthcare facilities.

Aimed to assess average ED stays of psychiatric patients and determine what degree transfer time contributed to their total time would help to determine what delay there was to providing acute psychiatric care due to the lack of after hours/on-site services.

Data was collected from the iPMS system. A total of 125 patients presented with primary psychiatric complaints between January 1, 2021 and December 31, 2021 and required onward transfer for acute psychiatric assessment or admission. Patients were excluded if less than 18 years or had been admitted to another WGH service before transfer. There are no existing guidelines in the National Clinical Program for Psychiatry or NICE guidelines for acute psychiatric patient transfer times or ED stays.

The average WGH ED attendance time was 15h 27min (range 0h08min and 19h22min). The longest interval contributing to overall time was Transfer Booked to Transfer Time (average 3h 27min). The time from Psychiatric Referral to Transfer accounted for 30% (on average) of patients’ attendance time.

There are significant delays in accessing acute psychiatric care due to the absence of Ambulance Service Bypass Protocols to transport patients to the most appropriate rather than the nearest ED. Proposed Trauma bypass system changes offer unique opportunities to review such inequity of access to acute psychiatric services.

Penetrating trauma is a highly visible issue in history, social media, and politics. Crime statistics showed increasing numbers of violations of the law banning assault weapons in Germany. Although these injuries have historically been rare in Germany, we have noticed increasing numbers in our hospital. Studies focusing on these injuries of penetrating trauma are lacking, hence a distinct therapy algorithm is missing.

All penetrating injuries proximal to the wrist and ankle in the years 2016-2021 were analyzed in a retrospective survey. Isolated injuries of hand and foot were excluded. Data were gathered from the clinical information system and the protocol of the emergency medical services. For further analysis we identified three distinct groups: Patients who acquired the injury by an accident (ACCIDENT), self-inflicted (SELF-HARM) or by crime (ASSAULT). The groups were compared using MicroSoft Excel® and Sigma plot® (Jandel, San Rafael, CA).

A total of 961 cases were identified. The analysis showed an increasing number of cases with penetrating injuries from 2016 until 2019. Furthermore, major differences between the groups were revealed. The assault victims (ASSAULT n=117) were mostly male (91%) and non-German (52%). They were more likely to be accompanied by the police (13%), to be intoxicated, to require hospital admission (also to critical care) and to require surgery as compared to the cases of the ACCIDENT (n=484) and SELF-HARM (n=360) group. The SELF-HARM group cases were predominantly female, younger and had psychiatric comorbidities.

The cause of penetrating trauma injury is important and can provide information crucial to the management of the patient. The emergency treatment of assault victims is challenging due to the particular circumstances of these cases. Optimal preparation and anticipation of the accident and emergency staff are necessary to deal with these patients. In summary, assault victims had more serious injuries than the other groups.

Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU ®,TR-DGU) and Israel (Israeli National Trauma Registry,INTR) in a retrospective analysis.

Patients from both registries treated during 2015-2019 with an Injury Severity Score (ISS) ≥ 16 points were included. Patient demographics, pre-hospital care, hospital treatment, and outcome were compared.

Data were available from 12,585 Israeli patients and 55,660 German patients. Age and sex distribution were comparable, and road traffic accidents were the most prevalent cause of injuries. The ISS of German patients was higher (ISS 24 versus 20), more patients were treated in an intensive care unit (92% versus 32%), and mortality was higher(19.4% versus 9.5%) as well.

Despite similar inclusion criteria (ISS ≥ 16), remarkable differences between the two national datasets were observed. Most likely, this was caused by different recruitment strategies of both registries like trauma team activation and the need for intensive care in TR- DGU. More detailed analyses are needed to uncover similarities and differences between both trauma systems.